The spontaneous breathing trial is of low predictive value regarding spontaneous breathing ability in subjects with prolonged, unsuccessful weaning.

BACKGROUND: The spontaneous breathing trial (SBT) is a well-established diagnostic test for predicting extubation failure in intubated intensive care unit (ICU) patients. However, the SBT has not been evaluated in a specific cohort of tracheostomized patients in whom weaning is prolonged and ultimately unsuccessful. OBJECTIVE: The aim of the trial was to investigate the relevance of SBT failure criteria in chronic respiratory failure subjects undergoing long-term invasive home mechanical ventilation following tracheostomy and weaning failure. METHODS: Measurement of all established failure criteria including pneumotachygraphical assessment of the rapid shallow breathing index (RSBI) took place during an SBT. The decision to continue spontaneous breathing was based on failure criteria as well as the subjective willingness of the patient. RESULTS: Fifteen subjects with a median age of 58 years (interquartile range [IQR] 44-74) were studied; 10 with COPD, 4 with neuromuscular diseases and 1 with both. Twelve subjects met the SBT failure criteria within 30 min, but one third of these subjects were still able to continue with spontaneous breathing. In contrast, 3 subjects could not be weaned despite the SBT being successful. An increased RSBI was the most frequently observed SBT failure criterion (57% of all SBT). However, the SBT varied substantially in individual subjects who were able to sustain spontaneous breathing, despite having reached the cut-off for SBT failure. CONCLUSION: The SBT was of low predictive value regarding spontaneous breathing ability in chronic respiratory failure subjects with prolonged, unsuccessful weaning.

[Home mechanical ventilation: Invasive and noninvasive ventilation therapy for chronic respiratory failure]. / Außerklinische Beatmung: Invasive und nichtinvasive Beatmungstherapie bei chronischer ventilatorischer Insuffizienz.

Home mechanical ventilation represents a valuable therapeutic option to improve alveolar ventilation in patients with chronic respiratory failure. For this purpose both invasive ventilation via tracheostomy and noninvasive ventilation via facemasks are available. The primary goal of home mechanical ventilation is a reduction of symptoms, improvement of quality of life and in many cases reduction of mortality. Elective establishment of home mechanical ventilation is typically provided for noninvasive ventilation in respect to clinical symptoms and partial pressure of carbon dioxide depending on the underlying disease. However, invasive mechanical ventilation is increasingly being used to continue ventilatory support in polymorbid patients following unsuccessful weaning. Recommendations and guidelines have been published by the German Respiratory Society (DGP).

Intermittent noninvasive ventilation at San José Hospital in Chile: report of a German donation.

Home mechanical ventilation is currently expanding in Chile, but its application along the country is hindered by financial and geographical reasons. In 2006 the San José Hospital in Santiago de Chile developed a non-invasive ventilation (NIV) center as a strategy to overcome the limitations of ventilator availability from public resources. Since then, this center provides intermittent diurnal sessions of NIV to patients with chronic hypercapnic respiratory failure. In 2013, a collaboratory work between the Chilean doctors, the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB = Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung) and the German non-invasive (NIV) home care provider "Heinen und Löwenstein" organized a donation of 100 second-hand ventilators (BiPAP Synchrony; Respironics, USA) including masks and tubing systems, which were provided by Heinen und Löwenstein. The ventilator devices arrived in Santiago in January 2014. Since then, the following initiatives have been launched: 1) the establishment of a domiciliary mechanical ventilation program independent of governmental founding, 2) NIV setting-titration, 3) renewal of ventilators at the hospital's intermittent NIV unit. Future goals are the establishment of a rehabilitation unit with concomitant NIV therapy and a clinical research program. Therefore, the German donation of ventilators and equipment has a reported impact on the development of NIV in Chile.